Patterns of protozoan infections: spatiotemporal associations with cattle density.

Waste from cattle production contains protozoa, such as Cryptosporidium spp. and Giardia, which can be transmitted to humans. People residing in areas of high cattle density may be at increased risk for protozoan infections. The objective of this study was to assess spatial and temporal associations between cattle density and hospitalizations for protozoan infections in the U.S. elderly. Data on protozoan infections were abstracted from Centers for Medicare and Medicaid Services datasets for a 14-year period (1991-2004). Cattle inventory data were abstracted from the 2002 U.S. Census of Agriculture. Counties were classified into one of five exposure categories based on both cattle density and human density. Our analyses considered differences in rates, trends, and variations in seasonal patterns based on exposure categories. Cryptosporidiosis demonstrated a trend of increasing annual rates related to increased potential exposure to cattle. Both cryptosporidiosis and giardiasis demonstrated significant seasonal patterns peaking during the fourth week of October in areas of high cattle/low population density and the second week of September in counties with low cattle/low human density, respectively. Counties with low human population density (regardless of cattle density) had the highest rate of all protozoan infections, peaking in the summer. These results demonstrate the elderly population is at increased risk of protozoan infections in areas of high cattle density, particularly cryptosporidiosis. The seasonal patterns and higher annual rates seen in rural areas suggest time-variant environmental exposures, which may be affected with geographical and temporal targeting of agricultural policies and interventions to improve public health.